Healthcare Provider Details

I. General information

NPI: 1093431207
Provider Name (Legal Business Name): BETHANY LYNN HILL RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2022
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 45TH ST S
FARGO ND
58103-0801
US

IV. Provider business mailing address

716 192ND ST S
HAWLEY MN
56549-9062
US

V. Phone/Fax

Practice location:
  • Phone: 612-799-9195
  • Fax:
Mailing address:
  • Phone: 612-799-9195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR048210
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2405289
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-136471
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR31814
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: